Permit ,� CITY OF TIGARD RESTRICTED ENERGY PERMIT
II t COMMUNITY DEVELOPMENT Permit #: ELR2011 -00208
T TGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/23/2011
Parcel: 2S114AA00100
Jurisdiction: Tigard
Site address: 9000 SW DURHAM RD
Project: Tigard High School Subdivision: Lot:
Project Description: CCTV system.
Contractor: HECKTEC TECHNICAL LLC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
3484 HILLSIDE CT 6960 SW SANDBURG ST
HUBBARD, OR 97032 TIGARD, OR 97223
PHONE. 503 - 572 -1938 PHONE
FAX 503 - 982 -4823
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/23/2011 $75 00
12% State Surcharge - Electrical 09/23/2011 $9 00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo N Boiler Controls: N
CCTV. Y Clock Systems: N
Data & Telecommunications N Fire Alarm: N
HVAC: N Instrumentation N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical' N
Nurse Calls N Protective Signal N
Security Alarm. N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio ' e er Th• e rules are set forth n - -OAR
952- 001 -0010 through OAR 952 - 001 -0090 You may obtain - .o. o or direct questions to OUNC by calling : 23 - 87 or r r 332
_ I �v.
Issued By: /liL� // / °!G� rmittee Signature: . . ,�lfi•I f ig
„ere OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application ' �� FOR O USE ONLY
ell Received L
City of Tigard a\ � Date /B O • ��� Permit No. �� (� _ �� =
® 13125 SW Hall Blvd., Tigard, OR 97223 ' — A 1 , `.\ Plan Review
' 0 ' Phone. 503.718 2439 Fax. 503 598I � `�'' �Q � Date /By Other Permit
T fG A R D Inspection Line 503.639 4175 ` Date Ready/By tuns See Page 2 for
Internet. www tigard- or.gov citk,4,7'
� `:� far' `. � '' Notified/Method / —1-6 Supplemental information
TYPE OF WORIO s (1. <i N PLAN REVIEW
❑ New construction Addition /alteration/repla
{ ce ' ment �x ?' Please check all that apply (submit 2 sets of plans w /items checked below):
‘.,#` c ' ❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: ,, .N where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling g Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address TOO d i more occupancy
T " -
✓ 1 ��� ❑ Six Six or or more re residential units ❑ Recreational vehicle parks
City/State /ZIP / q, /� � \ �! ❑ Hazardouse locations facilities ❑ Supply voltage for more than
L VVV LJ C ❑Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: / Il 04--00_ S El Service or feeder 600 amps or more
l' FEE SCHEDULE
Cross street/directions to job site. I Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 168 54 4
Ea add'l 500 sq ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 75 00 2
Limited energy, multi - family 75 00 2
CCT ✓ S e clIt-din residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200 34 2
Name:
601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
City/State/ZIP: 'temporary services or feeders installation, alteration, and /or
y relocation
Phone: ( ) Fax ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
APPLICANT ICI CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name C B Fee for branch circuits without
C KC \ P n CF / service or feeder fee, first
Contact name: 4 J ,� 4 C IL
branch circuit 56 18 2
t f " ` Each add'l branch circuit 7 42 2
Address: 314 �! I t Miscellaneous (service or feeder not included)
,�-� /J Each manufactured or modular 67 84 2
City /State /ZIP.Jf-C. LA' dwelling, service and/or feeder
Phone:95 ) , 7 2_ !g/�
_ 1 Fax: : ( ) M CJ 4 Reconnect only 67 84 2
7 1 Pump or irrigation circle 67 84 2
E - mail: -ec '+' C_ yv\S K_ Civ,." Sign or outline lighting 67 84 2
CONTRACTOR Signal circutt(s) or limited - energy
Business name: �p� — panel, alteration, or extension f Paget 7C di- 2
�� iv.� 1�1 s Each additional inspection over allowable in any of the above
Address: LI t (1 C� t C . Ve- Additional inspection (1 hr min) 66 25/ hr
l J "' ill investigation (1 hr mm) 66 25/ hr
City/State /ZIP: / � / ,/ Al Olt Industrial plant (1 hr min) 78.18/ hr
Phone:GO 57 Z - (g z---7 Fax: ( ) Inspections for which no fee is 90 00/ hr
�,/1/► specifically listed (% hr mm)
CCB Lie.: f(7 _ � �j c f Electrical Lie.: • � C - Suprv. ie.(/' / y ELECTRICAL PERMIT FEES
I ds Subtotal �S `�'-
Suprv. Electrician a I re required '71 l7 ki Plan review (25% of permit fee)
Print name: r Date: State surcharge (12% of permit fee)• q,-. 'a2-
e01 -vim �•t7 �
. A
TOTAL PERMIT FEE: Cwt
Authorized signature: .- p 1
'V „ (' ' (ig4P This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
Num of inspections allowed per permit.
I \Building\Permits\ELC- PermitApp doe 07/01/10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Prote • - e Signaling
--- —
Other LTV
]
Total number of commercial systems: 1
*No licenses are required. Licenses are required
1
for all other installations
1 \Buddmg\Permrts\ELC- PermrtApp doc 07/01/10